What are 5 late complications that can occur with extensive laryngeal fractures (Schaeffer's Group 3-5)?

Granulation Tissue

Vocal Cord Paralysis

Permanent Hoarseness

Airway Compromise (and difficulty with extubation)

Laryngeal Stenosis

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What are the three different types of nasal fractures?

Class I - fractures tend not to cause gross lateral displacement of the nasal bones

Class II - a frontal impact tends to comminute the nasal bones and cause gross flattening and widening of the dorsum while a lateral impact produces a high deviation of the nasal skeleton (complex "C-shaped")

Class III - also called the naso-orbito-ethmoid fractures & associated with fractures of the maxillae

Xanthelasma

50% association with elevated triglycerides

Molluscum Contagiosum

Verruca Vulgaris

Seborrheic Keratosis

Epidermal Cyst

Milium

Actinic Keratosis

Keratoacanthosis

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Comedones

Horns

Trichofolliculoma

Trichoepithelioma

Tricholemmoma

Pilomatrixoma

Nevus Sebaceous

Sebaceous Hyperplasia Rhinophyma

Hydrocystoma

Syringoma

Vascular Malformation

Hemangioma & Vascular Malformation

Soft-tissue Fibroma (Skin tag)

Adenoma Sebaceum

Hypertrophic Keloid

Neurofibroma

Fibroxanthoma

Dermatofibroma

Junctional Nevus

Junctional Nevus

Compound Nevus

Compound Nevus

Dermal Nevus

Dermal Nevus

Blue Nevus & Freckles

Nevus Ota Spitz Nevus

What are the treatment options for benign cutaneous skin lesions in the head and neck region?

It should be in a pocket just above to prevent clicking and shift off midline

What are the potential complications of external rhinoplasty?

Bleeding

Infection

Lateral notching from transcollumellar incision

Damage to caudal margin of medial crura and domes

What type of alar technique is typically preferred?

Complete strip

What are the NON-DELIVERY TECHNIQUE?

Cartilage-splitting & Retrograde Eversion

The non-delivery approach is suitable to achieve minor modifications of the nasal tip

(eg. increase in tip rotation, improvement in tip definition and access to the upper 2/3rds of the nose, when reduction techniques to dorsum are being planned). This approach involves only one incision, a transcartilaginous incision. The great advantage of this approach is its simplicity and easiness to perform, with good and predictable results.

The delivery approach allows more delicate tip work than the non-delivery approach. Two incisions are usually made for this approach: an intercartilaginous incision and a marginal incision. The approach is used to correct bifidity or asymmetry of the tip, to achieve extra tip rotation, to change tip projection, for precise excision of cartilage is possible, or to introduce and fixate cartilaginous grafts.

How much alar rim do you need to leave for alar support?

5mm

What are the three skin factors that may affect tip rhinoplasty?

Skin Thickness/Thinness

Number of Sebaceous Glands

Elastic/Collagen Content

What are 3 common tip abnormalities?

Tip Malposition - Over projected, Under projected, Under rotated (droopy), Over rotated

It is a type of genioplasty that involves mobilizing a horseshoe-shaped piece of the bottom part of the chin bone by osteotomy and sliding it either backwards or forwards, finally fixing it in place with a titanium step plate using titanium screws.

This type of surgery is usually performed by an oral and maxillofacial or plastic surgeon

What are four indications for sliding genioplasty?

Increase or decrease vertical mandibular height

Failed implant previously

Severe microgenia

Assymetrical mandible

1. Sliding Genioplasty

2. Alloplast

Silastic (supra or subperiosteal)

PTFE (supra or subperiosteal)

Porus polyethelene (supra or subperiosteal)

What does PTFE stand for?

Polytetrafluoroethylene which is a polymer that has many uses in head and neck surgery

What are complications of chin implantation?

Displacement

Bone resorption

Mental nerve injury

Hypertropic Scarring

Infection

Improper size selection

What are the types of implant for malar augmentation?

Silastic

PTFE

Porous Polyethelene

What is the surgical approaches for malar augmentation?

Intraoral incision, then subperiosteal on maxilla being careful of infraorbital nerve

Extraoral - external scar

What key parts of the patient history that are specifically important to chemical peeling?

What Fitzpatrick skin types more likely to have pigment changes with skin resurfacing techniques?

IV-VI

What are the standard patient and room precautions with the use of laser?

Patient - No flammable antiseptic, Eye shields, Wet gauze on all non-treated surfaces, Good communication with nursing & anesthesia, to keep on standby when not using, let the room know when you are using the laser

Aiming helium-neon beam. Water and dark pigment are the chromophore (& is therefore absorbed by Hemoglobin). Has more scatter, less precision and deeper penetration (Higher risk of injury). Ideal for: vacular malformations, pigmented tissues, used in pulmonary/urology/ gastroenterology procedures.

Has Fiberoptic carrier

Describe the Wavelength, Visibility, Absorption and whether it can be used fiberoptically, specifically for the ARGON laser?

Argon ? 514nm is the wavelength (blue-green visible)

Oxyhemoglobin is the chromophore (absorbed by the color red). Has use in retinal/otologic surgery, port-wine stains, vascular malformations, hemangiomas.

PDL lasers can be used as optical fiber to carry beam & is useful in office based procedures.

Describe the Wavelength, Visibility, Absorption and whether it can be used fiberoptically, specifically for the KTP laser?

Pottasium Titanyl Phosphate – 532nm is wavelength and is visible!

Oxyhemoglobin is the chromophore. Has use in otology, laryngology, and sinus surgery.

What are 5 things to consider to minimize scar tissue formation when repairing facial laceration?

1. Tissue eversion

2. Absorbable vs. nonabsorbable sutures

3. Patient's propensity for keloid/hypertrophic scar

4. Patients natural complextion (eg. light vs. dark)

5. Minimal tension on incision line

6. Clean wound, avoidance of infection

What are the indications for intralesional steroids?

1. Treatment of inflammatory condition

2. Soften or reduce keloids

3. Prevent recurrence after keloid excision

4. Acne cysts

5. Inflamed epidermal cysts

What are the Side-effects of intralesional steroids?

Atrophy

Striae

Stellate Pseudoscars

Telengectasias

Purpura

Erythema

Hypopigmentation

Delay in Wound Healing

Exacerbation of Cutaneous infections

*Only if >20mg injected per session!

Browpexy is an alternative approach which takes advantage of the exposure benefits of the upper eyelid incisions. ?Pexy? means to secure or fix. So typically it is done along with the upper eyelid or upper blepharoplasty procedure. Through that incision, after removal of the excess muscle and fat and a bit of skin or even without, the surgeon tunnels upward. The surgeon dissects up and over the bony portion of the eye socket or orbit such that he has freed up the eyebrow from some of its attachments. Then, using hidden stitches, the underside of the eyebrow is stitched to the firm fibrous tissue that covers the bone. Using multiple sutures, the eyebrow is ?fixed? at a higher, more desirable location.